Laparoscopic treatment of hydronephrosis in children with the horseshoe kidney: description of a case series

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Abstract

Introduction. The present research is a case series of laparoscopic treatment of pyeloureteral obstruction in 3 patients with a horseshoe kidney.

Material and methods. Laparoscopic treatment of hydronephrosis in three patients with the horseshoe kidney was performed by one surgeon (2 boys, 1 girl). Preoperative computed tomography confirmed the diagnosis and found a source of hydronephrosis – obstruction of the pyeloureteral segment. At laparoscopy, the horseshoe kidney anatomy was finally defined and the cause of the obstruction of the pyeloureteral segment was found too - high ureteral transposition from the pelvis or an aberrant vessel. Pyeloplasty performed by Anderson-Hynes technique was a final stage of the treatment.

Results. The lesion of the left kidney half was noted in 2 cases, of the right one – in 1 case. All three interventions were successfully performed laparoscopically without conversion to open surgery. Duration of surgical intervention varied from 60 to 90 minutes. Mean operative time was 75.0±15.0 min (median – 75.0 [67.5; 82.5] min). Average stay in ICU was 19.3±4.2 hours (median – 18.0 [17.0; 21.0] hours) with the longest interval being 24 hours in a younger patient due to tracheal decannulation problems .

The anteroposterior diameter of the pelvis was measured before surgery and 6 months after surgery. It was found that all patients had reduction in the pelvis size in average from 43.3±11.5 mm to 8.0±2.0 mm (median – 50.0 [40.0; 50.0] mm and 8.0 [7.0; 9.0] mm, respectively). Patients also showed a positive trend in the restoration of blood flow in the affected segment of the kidney. Resistance index changes were in averaged from 0.70±0.02 to 0.62±0.02 (median – 0.71 [0.70; 0.72] and 0.62 [0.61; 0.63], respectively).

Conclusion. Surgical treatment of hydronephrosis in patients with the horseshoe kidney is a complex problem, mainly because of the altered renal anatomy and variety of triggers that may cause hydronephrosis. Laparoscopic pyeloplasty is obviously a universal way to treat the discussed pathology.

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About the authors

Yury A. Kozlov

Irkutsk State Regional Children’s Clinical Hospital; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X

Chief Doctor , Irkutsk State Regional Children’s Clinical Hospital

Россия, 664022, Irkutsk; 664049, Irkutsk; 664003, Irkutsk

S. S. Poloyan

Irkutsk State Regional Children’s Clinical Hospital; Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0001-7042-6646
Россия, 664022, Irkutsk; 664003, Irkutsk

A. A. Marchuk

Irkutsk State Regional Children’s Clinical Hospital

Email: yuriherz@hotmail.com
ORCID iD: 0000-0001-9767-0454
Россия, 664022, Irkutsk

A. P. Rozhanski

Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0001-7922-7600
Россия, 664003, Irkutsk

A. A. Byrgazov

Irkutsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0002-9195-5480
Россия, 664003, Irkutsk

K. A. Kovalkov

Atamanov Kuzbass Regional Children’s Clinical Hospital; Kemerovo State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0001-6126-4198
Россия, 650056, Kemerovo; 650056, Kemerovo

Ch. B. Ochirov

Atamanov Kuzbass Regional Children’s Clinical Hospital

Email: yuriherz@hotmail.com
ORCID iD: 0000-0002-6045-1087
Россия, 650056, Kemerovo

V. M. Kapuller

Assuta University Medical Center, Ben-Gurion University

Author for correspondence.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-0076-5778

медицинский факультет

Израиль, Ashdod

A. N. Narkevich

Voino-Yasenetsky Krasnoyarsk State Medical University

Email: yuriherz@hotmail.com
ORCID iD: 0000-0002-1489-5058
Россия, 660022, Krasnoyarsk

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2. Fig. 1. Contrast computed tomography of kidneys (3D reconstruction): high ureteral transposition as a cause of hydronephrosis in the patient with a horseshoe kidney.

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3. Fig. 2. The aberrant vessel as the cause of hydronephrosis in the patient with a horseshoe kidney: a – contrast computed tomography image of kidneys, aberrant vessel is marked with an arrow; б – 3D reconstruction, site of vascular compression is marked with an arrow.

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4. Fig. 3. View of the horseshoe kidney during laparoscopy. The cause of hydronephrosis is high uretral transposition from the pelvis (1 – pelvis of the left renal segment, 2 – left ureter, 3 – pyeloureteral segment, 4 – horseshoe kidney isthmus).

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5. Fig. 4. View of the horseshoe kidney during laparoscopy. The cause of hydronephrosis is an aberrant inferior polar vein (1 – pelvis of the left renal segment, 2 – inferior polar vein, 3 – ureter of the left segment of the horseshoe kidney).

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6. Fig. 5. View of pyeloureteral anastomosis.

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Copyright (c) 2023 Kozlov Y.A., Poloyan S.S., Marchuk A.A., Rozhanski A.P., Byrgazov A.A., Kovalkov K.A., Ochirov C.B., Kapuller V.M., Narkevich A.N.

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